Screening in the direction of lung cancer hopes to save lives. But we must also watch out for possible damage

There is a lot to be praised about Australia Lung cancer screening programwhich began on July 1.

The program is based Golden standard Process evidence Showing this type of screening will probably reduce deaths due to lung cancer.

Some people will be extended due to this screening, which involves taking CT scans in low dose to search for lung cancer in people with a significant history of smoking.

In some of these people, cancer will be detected at an early stage and can be treated. Without screening, people could die of cancer because it would be detected at a later, incurable stage.

However, for some people, screening may also hurt.

How can browsing harm?

Screening for illness, in this cancerIN may cause damage – during screening, diagnosis and treatment.

Thanks to the screening of lung cancer, a positive scan can cause invasive lung biopsy. At this point, a pulmonary tissue sample is obtained with a special needle carried out by imaging or by surgery under anesthesia.

If, after a study under a microscope, a pathologist believes that there is lung cancer, then there will probably be a more extensive surgery and other treatment, all of which have the risk of side effects.

The diagnostic label “lung cancer” itself is disturbing, and the stigma attached to the diagnosis can worsen this anxiety.

These damage and risk can be considered acceptable if the treatment prevents the progress of a person’s cancer.

However, as in the case of other cancers, screening will probably also cause excessive diagnosis and excessive treatment. This means that some changes taken through screening and diagnosed as cancer would never cause any problems if they stayed alone. If these changes remained undetected (and untreated), they would never cause symptoms or shorten the life of a person.

But all patients with cancer diagnosis will be offered treatment – including surgery, radiation and anti -cancer drugs. However, patients who really have a lethargic (not death) change have the same risk of damaging diagnosis and treatment as others, but without potential treatment.

A related problem is “accidental findings”. Reports on screening programs in the field of lung cancer abroad show great potential Find things other than cancer on the CT scan.

For example, some people have lungs (miniature places on the skan) that are not suspicious in the case of cancer, but still require strict monitoring with repeated scans. For these people, we must make sure that healthcare employees follow protocols that prevent unnecessary intervention in a nodule that is not developing.

The scans can also pick up other conditions. These include calcium in coronary arteries, miniature aortic aneurysms (bulges in the greatest body artery) or abnormalities in the abdominal organs such as liver.

Some of these “random findings” can lead to early detection of the disease that can be treated. However, in many cases the findings It would not cause any problems if they were not detectedAnother example Excessive diagnosis. These patients experience the risk of further cascades of interventions caused by accidental discovery, but without these interventions that improve their health.

The potential for excessive diagnosis and excessive treatment is greater if screening goes beyond a high -risk group with the history of severe smoking. Some people who do not meet the eligibility criteria may still want to be examined. For example, campaigns to make lung cancer aware of people who do not smoke, asking for screening. If screening employees decide to imagine them, this may cause an unofficial “leakage” of the screening program, which includes people with lower risk of cancer.

For example, in the United States, estimated 45% of the scans made In the screening program, it applies to people who do not meet the eligibility criteria. In China, about 64% Of the proven people, it can be technically non -eligible.

We see the results of this in many Asian countries with widespread, non -mendary research, including people who do not smoke. This caused high indicators of cancer diagnosis-significantly higher than you can expect in this low risk group-even higher indicators Lung operations.

These operations that include cutting in the chest wall to remove lung tissue have a significant operational risk. They can also cause long -term impacts by removing normal pulmonary tissue.

Regular independent assessment needed

In Australia, for a qualifying population with a significant history of smoking, we anticipate the net benefit, off -balance, and from the screening program.

However, if the unintentional consequences of screening are higher in real life than in trials, it can tilt it to net detriment.

So, Regular independent re -evaluation The program is needed to ensure the expected benefits and the damage is restricted to a minimum.

This should include data analysis in the population to look for signs of benefits, such as a decrease in lung cancer and advanced death indicators.

These data should also be examined in terms of the symptoms of damage resulting from excessive diagnosis and excessive treatment-in both cancer and non-cancer conditions.

The potential of screening for lung cancer there are many emotions to prevent the death of some Australians from this destructive disease. We also have cautious optimism that the program can really have a difference.

But we cannot allow us to blind us to the potential of damage.

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This is the next article from our series “Finding Lung Cancer”, which is investigating the first up-to-date cancer screening program in Australia for almost 20 years. Read other articles in the series.

There is more information about the program available. If you need support to quit smoking, call Quitline at 13 78 48.